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["令和　　年　　月　　日　　"]
[]
["　千葉市保健所感染症対策課長　様"]
[]
["組　織　名：　　　　　　　　　　　"]
["代表者氏名：　　　　　　　　　　　"]
[]
[]
["感染症予防教室　実施申込書"]
[]
["参加対象者　"]
["参加予定人数　","　　　　　人　（内訳：　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
["希望する\nテーマ"]
["希望日時","第１希望","　　　　　年　　　　　月　　　　　日（　　）"]
[null,null,"　　　　時　　　　分　　～　　　　　時　　　　分"]
[null,"第２希望","　　　　　年　　　　　月　　　　　日（　　）"]
[null,null,"　　　　時　　　　分　　～　　　　　時　　　　分"]
[null,"第３希望","　　　　　年　　　　　月　　　　　日（　　）"]
[null,null,"　　　　時　　　　分　　～　　　　　時　　　　分"]
["会場名"]
[null,"【テーマ３を選択の場合必須】会場内蛇口数：　　　個　",null,null,"（駐車場：　　　　・　　　　　）"]
["会場住所\n※市内のみ","千葉市"]
["機材","［準備可能な機材にチェックを入れてください］"]
[]
[]
["担当者","部署・氏名"]
[null,"電話番号"]
["その他\n連絡事項等"]

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["2025-04-01"]
[]
["　千葉市保健所感染症対策課長　様"]
[]
["組　織　名：千葉市立〇〇小学校"]
["代表者氏名：校長　●●　●●　"]
[]
[]
["感染症予防教室　実施申込書"]
[]
["参加対象者　"]
["参加予定人数　","　３５人　（内訳：１年１組の生徒３３人、先生２人）"]
["希望する\nテーマ","3　手洗いチェッカーを使った正しい手洗い教室"]
["希望日時","第１希望","令和７年１０月１日（水）"]
[null,null,"１５時００分　～　１６時００分"]
[null,"第２希望","令和７年１０月２日（木）"]
[null,null,"１５時００分　　～　１６時００分"]
[null,"第３希望","令和７年１０月３日（金）"]
[null,null,"１５時００分　　～　１６時００分"]
["会場名","千葉市立〇〇小学校の家庭科室"]
[null,"【テーマ３を選択の場合必須】会場内蛇口数：８個　",null,null,"（駐車場：　　　　・　　　　　）"]
["会場住所\n※市内のみ","千葉市","中央区","□□１－２－３　"]
["機材","［準備可能な機材にチェックを入れてください］"]
[]
[]
["担当者","部署・氏名","保健室　養護教諭　■■　■■"]
[null,"電話番号","０４３－１２３－４５６７（代表）"]
["その他\n連絡事項等","　当日、学校に到着した際は■■までご連絡ください。駐車場までご案内いたします。"]